Special report: Insight into the future of laser eye surgery

Leading ophthalmic expert discovers laser treatment to counteract ageing of the eyes

Professor Dan Reinstein helped to invent Blended Laser Vision, which can correct sight problems caused by ageing of the eye

In this article, Professor Dan Reinstein of the London Vision Clinic explores the latest advancements in laser eye surgery and how technology will soon be so advanced surgeons will be able to offer laser eye correction to the small number of patients who do not currently qualify for treatment

Advances in ophthalmic laser technology mean doctors are now able to restore 20/20 vision to patients who were previously considered too short or long sighted to qualify for treatment.

One to two per cent of people who wear glasses have a prescription currently outside the laser eye treatment range. But, experts say, that the limits of correction have now been expanded significantly.

Speaking to BBH this week, Professor Dan Reinstein of the London Vision Clinic said that over the past 20 years ophthalmic lasers have become so advanced that for the vast majority of cases, there is unlikely to be much in the way of advances. However, he said the direction of travel would be towards making the most-advanced lasers now available work for more people.

“In terms of development, some, but not all, of the laser systems on the market are so advanced that for about 95% of the population who wear glasses, we are at a place where we cannot really improve things much further,” he added. “What will change in the coming years, though, is just what we can do with these more advanced lasers.

“We are treating patients conveniently, painlessly and effectively and the next stage is to look at how we get the solution to those few people who do not qualify and how do we do that without having to place plastic lenses into the eye.”

We are treating patients conveniently, painlessly and effectively and the next stage is to look at how we get the solution to those few people who do not qualify and how do we do that without having to place plastic lenses into the eye

Working with world’s leading optical device company, Carl Zeiss, Professor Reinstein is responsible for one of the biggest advancements in laser eye surgery of recent years. As an off-shoot of Professor Reinstein’s research in correcting the night vision of patients with previous laser eye surgery in the 1990s, he discovered an element which led him to develop the concept being Laser Blended Vision. Carl Zeiss implemented this into their laser platform in 2009, meaning that anyone can now have their vision corrected for distance and near sight, despite ageing eyes.

He explained: “Traditional LASIK or laser eye surgery corrects distance vision, but does not deal with the effects of ageing of the eye. The trend in recent years to save you from reading glasses or bifocals for most surgeons has been to implant synthetic lenses surgically into the eye. Laser Blended Vision is a much safer option because it is done without entering the eye so is much less invasive.

“Laser Blended Vision can significantly reduce, or even eliminate, the need for reading glasses, bifocals or varifocals for many years and is adjustable as we age. Most people may need a top-up five to 10 years later once or twice to stay out of reading glasses for the rest of their lives.”

The effect of age on the eye is called presbyopia, literally translated as ‘old eye’. Starting in early middle age, the lens inside the eye begins to lose its ability to change shape and provide the ‘zoom’ required to focus from distance to close up and back. Absolutely everyone will suffer this to some degree at some point and will usually corrective glasses or lenses.

Laser Blended Vision works in two ways. Firstly, it increases the depth of focus of the eye, meaning that light rather than being focused to a point – as is done by glasses or contact lenses – is focused over a zone. In addition the eyes are treated slightly differently. The dominant, or lead eye, is adjusted to see mostly at distance, and a little close up; while the other is the opposite - mostly up close and a little at distance. In 97% of people, the brain compensates for this by blending the two images together because they are not that different. It combines the two images to give greater depth of vision and an all-round improvement in sight that means most patients no longer need reading glasses. This is quite different from monovision which, as the name implies, one eye sees only at near and the other only at distance; only about 50% of people can put the images from the eyes together when they are that different.

Professor Reinstein said: “Lots of people put on their reading glasses and when you ask them why they don’t have laser eye surgery they tell you it can’t be done and that age means they will inevitably need reading glasses. Although this technology has been on the market since 2009, it still surprises people that this perception is not true. There continues to be a ‘wow’ factor.

The trend in recent years to save you from reading glasses or bifocals for most surgeons has been to implant synthetic lenses surgically into the eye. Laser Blended Vision is a much safer option because it is done without entering the eye so is much less invasive

“Whether you have worn glasses or not in the past, your eyes will change as you get older and you will need bifocals or varifocals or reading glasses. No one escapes presbyopia.

“Now, just like with traditional laser eye surgery, we can address this natural ageing and, with the same recovery time as normal laser surgery, we can get rid of this extremely annoying inconvenience or, some might say, disability. People who need glasses find it affects every single minute of their waking day. It is wonderful to be able to do something that will have such as huge impact on people every second they are awake.”

The equipment to carry out the surgery costs £750,000 and currently in the UK the treatment is only available at the London Vision Clinic.

Professor Reinstein said: “We have made the optics much more sophisticated, so now instead of focusing light on a point of infinity, we focus it on the region or zones where the sight is still in focus. By doing this we can correct distance and reading vision at the same time.”

And the enormous recent advancement in laser technology means all these treatments can now be done via keyhole surgery.

“Two things have revolutionised laser eye surgery in recent years,” said Professor Reinstein. “The first is this ability to correct reading vision. The other is that we can do this through a keyhole procedure. That’s incredible. It is like Star Trek .

“Keyhole surgery has extended the range of patients we can treat considerably. Before this, laser surgery could correct prescriptions up to -8. Keyhole surgery allows up to do prescriptions up to -14. These are people who would in the past have had a synthetic lens put inside the eye because laser eye surgery could not safely help them. Now surgeons can treat them without going into the eye.

“The next step is definitely to increase this coverage to those few people who do not currently qualify and to find a way of doing the procedure without going inside the eye and instead going onto the cornea.”

One patient who has already been treated using the Laser Blended Vision is TV presenter, Phillip Schofield. He said of the technology: “My eyes weren’t very bad, but I was beginning to look a bit stupid because I had about 10 pairs of glasses on my head. It was getting to the stage where I was squinting at everything.”

In terms of development, some, but not all, of the laser systems on the market are so advanced that for about 95% of the population who wear glasses, we are at a place where we cannot really improve things much further

Professor Reinstein carried out the surgery after spending three hours testing Schofield’s vision. To correct his sight problems, the thickness of his cornea was changed by just half the thickness of a single human hair.

Following surgery, Schofield said: “I wasn’t expecting miracles on first day, but just after the surgery I could see far away incredibly clearly. I could also see close up. My vision is now better than 20/20. It’s fighter jet pilot standard.”

The procedure normally costs in excess of £4,600 and patients are followed up six times over the year after surgery.

“We never discharge patients; we continue to follow them on a yearly or biannual basis because I believe in looking after the health of the eye at a high standard than is commonly practiced in the high street.”

Postscript:
After reading this article, HPCi Media's CIO, Steve Maller, underwent surgery at the London Vision Clinic in September 2012...and is happy with the results.

Laser Blended Vision is enabling surgeons to offer corrective surgery to more patients than ever before and means they can correct age damage as well as distance vision